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Pg1}{\bkmkend Pg1}\par\pard\ql \li8603\sb488\sl-644\slmult0 \up0 \expndtw0\charscalex92 \ul0\nosupersub\cf1\f2\fs56 Client Alert \par\pard\ql \li10045\sb0\sl-207\slmult0 \par\pard\ql\li10045\sb0\sl-207\slmult0 \par\pard\ql\li10045\sb0\sl-207\slmult0 \par\pard\ql\li10045\sb36\sl-207\slmult0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf3\f4\fs18 February 2013 \par\pard\ql \li2414\sb278\sl-322\slmult0 \up0 \expndtw-12\charscalex100 \ul0\nosupersub\cf6\f7\fs28 Now Is The Time To Revise Your Business Associate Agreements \par\pard\ql \li4336\sb38\sl-322\slmult0 \up0 \expndtw-11\charscalex100 and Notice of Privacy Practices \par\pard\ql \li3867\sb16\sl-276\slmult0 \up0 \expndtw-11\charscalex96 \ul0\nosupersub\cf7\f8\fs24 Julie A. Simer, Esq. and Brooke J. Ledger, Esq.\par\pard\sect\sectd\sbknone\cols2\colno1\colw6103\colsr160\colno2\colw5837\colsr160\ql \li719\sb0\sl-230\slmult0 \par\pard\ql \li720\sb85\sl-230\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf9\f10\fs20 There is a lot of confusion among providers caused by the\par\pard\qj \li719\ri205\sb2\sl-244\slmult0\fi0 \up0 \expndtw-3\charscalex100 recent publication of new rules under the Health Insurance \up0 \expndtw-3\charscalex100 Portability and Accountability Act of \up0 \expndtw-2\charscalex100 1996 \up0 \expndtw-3\charscalex100 (\u8220?HIPAA\u8221?). On\par\pard\qj \li719\ri204\sb0\sl-244\slmult0\fi0 \up0 \expndtw-6\charscalex100 January 25, 2013, the HIPAA final omnibus rule (\u8220?Final Rule\u8221?) \line \up0 \expndtw-8\charscalex100 issued by the U.S. Department of Health and Human Services \line \up0 \expndtw-5\charscalex100 (\u8220?HHS\u8221?) was published in the Federal Register (78 FR \up0 \expndtw-2\charscalex100 5565).\par\pard\qj \li719\ri204\sb0\sl-244\slmult0\fi0 \up0 \expndtw-3\charscalex100 The Final Rule is actually four rules rolled into one massive \up0 \expndtw-3\charscalex100 523\u8208?page rule. The Final Rule changes the requirements \up0 \expndtw-2\charscalex100 necessary to protect the privacy and security of protected \up0 \expndtw-4\charscalex100 health information (\u8220?PHI\u8221?) under the HIPAA Privacy, Security \up0 \expndtw-6\charscalex100 and Enforcement Rules. The Final Rule strengthens protection \up0 \expndtw-1\charscalex100 for PHI and heightens breach\u8208?reporting obligations. For \up0 \expndtw-8\charscalex100 providers, it will require:\par\pard\ql \li719\sb0\sl-230\slmult0 \par\pard\ql \li719\sb26\sl-230\slmult0 \up0 \expndtw-7\charscalex100 1. Revising Existing Notices of Privacy Practice\par\pard\qj \li719\ri1073\sb3\sl-244\slmult0\fi0\tx901 \up0 \expndtw-6\charscalex100 2. Revising Existing Business Associate Agreements \up0 \expndtw-7\charscalex100 3. Requiring Business Associates to Execute Business \line\tab \up0 \expndtw-6\charscalex100 Associate Agreements With Subcontractors\par\pard\ql \li719\sb0\sl-230\slmult0 \par\pard\ql \li719\sb27\sl-230\slmult0 \up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf10\f11\fs20 Deadline for Compliance\par\pard\qj \li719\ri204\sb5\sl-243\slmult0 \up0 \expndtw-7\charscalex100 \ul0\nosupersub\cf9\f10\fs20 The date for compliance with the Final Rule is September 23, \up0 \expndtw-8\charscalex100 2013. However, if a business associate agreement was in effect \up0 \expndtw-8\charscalex100 prior to January 25, 2013, a new business associate agreement \up0 \expndtw-4\charscalex100 is not necessary until the existing agreement is modified or \up0 \expndtw-2\charscalex100 renewed, or September \up0 \expndtw-2\charscalex100 23, \up0 \expndtw0\charscalex100 2014, whichever is earlier.\par\pard\qj \li719\ri204\sb2\sl-243\slmult0 \up0 \expndtw-1\charscalex100 However, this does not mean that a provider has time to \up0 \expndtw-8\charscalex100 waste. Important steps must begin now.\par\pard\ql \li719\sb0\sl-230\slmult0 \par\pard\ql \li719\sb26\sl-230\slmult0 \up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf10\f11\fs20 Conduct an Immediate Inventory\par\pard\qj \li719\ri204\sb4\sl-244\slmult0\fi0 \up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf9\f10\fs20 The Final Rule expands the definition of \u8220?business associate.\u8221? \line \up0 \expndtw-5\charscalex100 The term now includes subcontractors of business associates \line \up0 \expndtw-8\charscalex97 as well as those who create, receive, maintain, or transmit PHI, \line \up0 \expndtw-5\charscalex100 even if the PHI is never accessed. However, there are some \line \up0 \expndtw-6\charscalex100 nuances to this rule; for example, a business such as an \line \up0 \expndtw-8\charscalex97 Internet service provider, which only acts as a conduit for data, \line \up0 \expndtw-8\charscalex100 does not need to execute a business associate agreement, but \line \up0 \expndtw-1\charscalex100 a storage company that maintains paper records does. \line \up0 \expndtw-6\charscalex100 Consequently, there are many types of existing arrangements \line \up0 \expndtw-2\charscalex100 that now need business associate agreements that did not \line \up0 \expndtw-7\charscalex100 need them in the past. Therefore, providers must immediately \line \up0 \expndtw-2\charscalex100 inventory all of their arrangements with entities that have \line \up0 \expndtw-3\charscalex100 access to PHI and determine (a) whether the arrangement \line \up0 \expndtw-1\charscalex100 requires a business associate agreement, (b) if a business\par\pard\column \ql \li6263\sb0\sl-230\slmult0 \par\pard\ql \li20\sb85\sl-230\slmult0 \up0 \expndtw-6\charscalex100 associate agreement has been executed, and (c) the date any\par\pard\qj \li20\ri648\sb2\sl-244\slmult0\fi0 \up0 \expndtw-4\charscalex100 executed business associate agreement will expire or be \up0 \expndtw-3\charscalex100 renewed.\par\pard\ql \li6263\sb0\sl-230\slmult0 \par\pard\ql \li20\sb25\sl-230\slmult0 \up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf10\f11\fs20 Communicate with Your Business Associates\par\pard\qj \li20\ri647\sb4\sl-244\slmult0\fi0 \up0 \expndtw-8\charscalex97 \ul0\nosupersub\cf9\f10\fs20 Once the inventory is complete, it is time to communicate with \line \up0 \expndtw-8\charscalex100 business associates about the need to conduct an inventory of \line \up0 \expndtw-3\charscalex100 arrangements with subcontractors. Business associates must \line \up0 \expndtw0\charscalex103 execute business associate agreements with any \line \up0 \expndtw-6\charscalex100 subcontractors who create, receive, maintain, or transmit PHI. \line \up0 \expndtw-8\charscalex100 The minimum necessary standard applies to the use of PHI by \line \up0 \expndtw-7\charscalex100 business associates and subcontractors, so they will each need \line \up0 \expndtw-8\charscalex97 to have policies in place to prevent unnecessary access to PHI.\par\pard\ql \li6263\sb0\sl-230\slmult0 \par\pard\ql \li20\sb26\sl-230\slmult0 \up0 \expndtw-7\charscalex100 \ul0\nosupersub\cf10\f11\fs20 Review Your Business Associate Agreement\par\pard\qj \li20\ri875\sb3\sl-244\slmult0 \up0 \expndtw-9\charscalex97 \ul0\nosupersub\cf9\f10\fs20 A sample of a new business associate agreement is provided \up0 \expndtw-9\charscalex95 on the HHS website at\par\pard\qj \li20\ri712\sb0\sl-244\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf11\f12\fs20 http://www.hhs.gov/ocr/privacy/hipaa/understanding/covere \up0 \expndtw-3\charscalex100 dentities/contractprov.html.\par\pard\qj \li20\ri647\sb0\sl-244\slmult0\fi0 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf9\f10\fs20 However, before you start using the HHS form, or one \line \up0 \expndtw-8\charscalex100 prepared by a vendor, consider whether the form provides the \line \up0 \expndtw-6\charscalex100 necessary protection from liability. Data breaches can result in \line \up0 \expndtw-6\charscalex100 significant fines and penalties, as well as liability for damages. \line \up0 \expndtw-7\charscalex100 A provider may choose to include indemnity provisions in the \line \up0 \expndtw-3\charscalex100 business associate agreement to appropriately place liability \line \up0 \expndtw-2\charscalex100 upon the business associate in the event the business \line \up0 \expndtw-1\charscalex100 associate or a subcontractor causes the breach. The form \line \up0 \expndtw-4\charscalex100 business associate agreement provided by HHS does not \line \up0 \expndtw-7\charscalex100 address such liability issues.\par\pard\qj \li20\ri647\sb243\sl-244\slmult0\fi0 \up0 \expndtw-8\charscalex97 Also, note that the increased penalties under the Final Rule are \up0 \expndtw-7\charscalex100 assessed \u8220?per violation,\u8221? so penalties can add up quickly when \up0 \expndtw-1\charscalex100 the records of many individuals are lost or disclosed. The \up0 \expndtw-4\charscalex100 business associate agreement should specify how and when \up0 \expndtw-7\charscalex100 the provider will be notified of a breach and who will provide \up0 \expndtw-8\charscalex100 the notice to affected individuals.\par\pard\qj \li21\ri646\sb244\sl-244\slmult0\fi0 \up0 \expndtw-4\charscalex100 Under previous rules, the business associate agreement was \line \up0 \expndtw-4\charscalex100 required to include a provision that if the business associate \line \up0 \expndtw-6\charscalex100 agreement could not terminate the contract upon notice of a \line \up0 \expndtw-5\charscalex100 material breach by the physician, the business associate was \line \up0 \expndtw-4\charscalex100 required to notify the Secretary of HHS. That provision is no \line \up0 \expndtw-8\charscalex100 longer required, so physicians will want to act quickly to revise \par\pard\sect\sectd\sbknone \ql \li727\sb0\sl-161\slmult0 \par\pard\ql\li727\sb0\sl-161\slmult0 \par\pard\ql\li727\sb0\sl-161\slmult0 \par\pard\ql\li727\sb15\sl-161\slmult0 \up0 \expndtw-5\charscalex97 \ul0\nosupersub\cf4\f5\fs14 This alert is published as a service to our clients and friends. The material contained here is provided for informational purposes only and is not intended to constitute advertising, solicitation \par\pard\ql \li4299\sb19\sl-161\slmult0 \up0 \expndtw-5\charscalex100 or legal advice. For more information, visit \ul0\nosupersub\cf5\f6\fs14 www.buchalter.com\ul0\nosupersub\cf4\f5\fs14 . \par\pard\sect\sectd\fs24\paperw12240\paperh15840{\shp
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Pg2}{\bkmkend Pg2}\par\pard\ql \li8603\sb488\sl-644\slmult0 \up0 \expndtw0\charscalex92 \ul0\nosupersub\cf1\f2\fs56 Client Alert \par\pard\ql \li10045\sb0\sl-207\slmult0 \par\pard\ql\li10045\sb0\sl-207\slmult0 \par\pard\ql\li10045\sb0\sl-207\slmult0 \par\pard\ql\li10045\sb36\sl-207\slmult0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf3\f4\fs18 February 2013\par\pard\sect\sectd\sbknone\cols2\colno1\colw6103\colsr160\colno2\colw5837\colsr160\ql \li719\sb0\sl-230\slmult0 \par\pard\ql \li720\sb67\sl-230\slmult0 \up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf9\f10\fs20 their business associate agreements to make it clear that the\par\pard\qj \li719\ri205\sb3\sl-244\slmult0 \up0 \expndtw-7\charscalex100 business associate does not have to notify the Secretary under \up0 \expndtw-5\charscalex100 such circumstances.\par\pard\ql \li719\sb0\sl-230\slmult0 \par\pard\ql \li719\sb26\sl-230\slmult0 \up0 \expndtw-8\charscalex100 \ul0\nosupersub\cf10\f11\fs20 Revise Your Notice of Privacy Practices\par\pard\qj \li719\ri205\sb3\sl-244\slmult0\fi0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf9\f10\fs20 Under the Final Rule, health care providers with a direct \up0 \expndtw-4\charscalex100 treatment relationship with an individual must revise and \up0 \expndtw-3\charscalex100 redistribute their Notice of Privacy Practices \up0 \expndtw-1\charscalex100 (\u8220?Notice\u8221?). In\par\pard\qj \li719\ri205\sb0\sl-244\slmult0 \up0 \expndtw-4\charscalex100 addition to previously mandated requirements, the Notice \up0 \expndtw-7\charscalex100 must include these statements:\par\pard\qj \li719\ri204\sb11\sl-244\slmult0\tx900 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf12\f13\fs20 \u-3913?\ul0\nosupersub\cf13\f14\fs20 \ul0\nosupersub\cf9\f10\fs20 The right to be notified in the event of a breach of the \line\tab \up0 \expndtw-5\charscalex100 individual\u8217?s PHI;\par\pard\qj \li720\ri204\sb10\sl-244\slmult0\tx900\tx899 \up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf12\f13\fs20 \u-3913?\ul0\nosupersub\cf13\f14\fs20 \ul0\nosupersub\cf9\f10\fs20 The right to request that a health plan not be informed of \line\tab \up0 \expndtw-7\charscalex100 treatment which is paid for in full by the individual, and the \line \tab \up0 \expndtw-9\charscalex100 covered entity\u8217?s obligation to comply with such a request;\par\pard\qj \li719\ri204\sb11\sl-244\slmult0\tx900\tx900 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf12\f13\fs20 \u-3913?\ul0\nosupersub\cf13\f14\fs20 \ul0\nosupersub\cf9\f10\fs20 That consent is required prior to the use or disclose of an \line\tab \up0 \expndtw-1\charscalex100 the individual\u8217?s psychotherapy notes, or the use the \line \tab \up0 \expndtw-7\charscalex100 individual\u8217?s PHI for marketing purposes;\par\pard\qj \li719\ri205\sb11\sl-244\slmult0\tx900 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf12\f13\fs20 \u-3913?\ul0\nosupersub\cf13\f14\fs20 \ul0\nosupersub\cf9\f10\fs20 The right to opt out of communications for fundraising \line\tab \up0 \expndtw-3\charscalex100 purposes;\par\pard\qj \li720\ri204\sb11\sl-244\slmult0\tx899\tx899 \up0 \expndtw-7\charscalex100 \ul0\nosupersub\cf12\f13\fs20 \u-3913?\ul0\nosupersub\cf13\f14\fs20 \ul0\nosupersub\cf9\f10\fs20 A statement that a health plan is prohibited from disclosing \line\tab \up0 \expndtw-3\charscalex100 genetic information for underwriting purposes (applies to \line \tab \up0 \expndtw-7\charscalex100 health plans only).\par\pard\qj \li719\sb0\sl-244\slmult0 \par\pard\qj \li719\ri204\sb1\sl-244\slmult0\fi0 \up0 \expndtw-4\charscalex100 Note that business associates are not required to provide a \line \up0 \expndtw-5\charscalex100 Notice unless such responsibility is delegated to the business \line \up0 \expndtw0\charscalex101 associate, making it a contractual requirement, not a \line \up0 \expndtw-5\charscalex100 requirement of the Final Rule. Providers must revise and \line \up0 \expndtw-4\charscalex100 prominently post Notices on or promptly after the effective \line \up0 \expndtw-5\charscalex100 date of March 26, 2013. Although providers do not need to \line \up0 \expndtw-8\charscalex97 mail the new Notice to all existing patients, they must post the \line \up0 \expndtw-2\charscalex100 revised Notice in a clear and prominent location and have \line \up0 \expndtw-1\charscalex100 copies of the Notice at the delivery site for individuals to \line \up0 \expndtw-7\charscalex100 request to take with them. Providers are only required to give \line \up0 \expndtw0\charscalex105 a copy of the Notice to, and obtain a good faith \line \up0 \expndtw-7\charscalex100 acknowledgment of receipt from, new patients. Providers may \line \up0 \expndtw-3\charscalex100 post a summary of the Notice as long as the full Notice is \line \up0 \expndtw-4\charscalex100 immediately available (such as on a table directly under the \line \up0 \expndtw-6\charscalex100 posted summary) for individuals to pick up. It is not sufficient \line \up0 \expndtw-6\charscalex100 to require the individual to ask the receptionist for a copy of \line \up0 \expndtw-8\charscalex100 the full Notice.\par\pard\ql \li719\sb0\sl-230\slmult0 \par\pard\ql \li719\sb26\sl-230\slmult0 \up0 \expndtw-7\charscalex100 \ul0\nosupersub\cf10\f11\fs20 Steps Going Forward\par\pard\qj \li719\ri204\sb13\sl-244\slmult0\tx899 \up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf12\f13\fs20 \u-3913?\ul0\nosupersub\cf13\f14\fs20 \ul0\nosupersub\cf9\f10\fs20 Conduct a risk assessment to determine the likelihood of a \line\tab \up0 \expndtw-6\charscalex100 data breach.\par\pard\qj \li720\ri204\sb11\sl-244\slmult0\tx900 \up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf12\f13\fs20 \u-3913?\ul0\nosupersub\cf13\f14\fs20 \ul0\nosupersub\cf9\f10\fs20 Update compliance policies for obtaining business associate \line\tab \up0 \expndtw-8\charscalex100 agreements and distributing the Notice of Privacy Practices\par\pard\column \ql \li6263\sb0\sl-230\slmult0 \par\pard\ql \li20\sb78\sl-230\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf12\f13\fs20 \u-3913?\ul0\nosupersub\cf13\f14\fs20 \ul0\nosupersub\cf9\f10\fs20 Update an incidence response plan identifying the\par\pard\qj \li20\ri647\sb0\sl-249\slmult0\fi180\tx211 \up0 \expndtw-9\charscalex96 procedure to be followed in the event of a security breach. \up0 \expndtw-7\charscalex100 \ul0\nosupersub\cf12\f13\fs20 \u-3913?\ul0\nosupersub\cf13\f14\fs20 \ul0\nosupersub\cf9\f10\fs20 Set up monitoring and internal audits to avoid lapses in the \line\tab \up0 \expndtw-9\charscalex97 privacy and security of PHI.\par\pard\qj \li20\ri648\sb243\sl-244\slmult0\fi0 \up0 \expndtw-4\charscalex100 There is no reason to wait until the last minute; the time is \up0 \expndtw-5\charscalex100 now to review business associate agreements and Notices of \up0 \expndtw-7\charscalex100 Privacy Practices to avoid unexpected liability.\par\pard\ql \li7565\sb0\sl-230\slmult0 \par\pard\ql \li1322\sb26\sl-230\slmult0 \up0 \expndtw-9\charscalex95 \ul0\nosupersub\cf14\f15\fs20 Julie A. Simer is a Shareholder in the firm\u8217?s\par\pard\ql \li1322\sb14\sl-230\slmult0 \up0 \expndtw-9\charscalex96 Health Care Practice Group. She can be\par\pard\ql \li1322\sb13\sl-230\slmult0 \up0 \expndtw-7\charscalex100 reached at 949.224.6259 or\par\pard\ql \li1322\sb15\sl-230\slmult0 \up0 \expndtw-3\charscalex100 jsimer@buchalter.com.\par\pard\ql \li7565\sb0\sl-230\slmult0 \par\pard\ql \li7565\sb0\sl-230\slmult0 \par\pard\ql \li1322\sb172\sl-230\slmult0 \up0 \expndtw-9\charscalex95 Brooke J. Ledger is an Associate in the firm\u8217?s\par\pard\ql \li1322\sb13\sl-230\slmult0 \up0 \expndtw-9\charscalex96 Health Care Practice Group. She can be\par\pard\ql \li1322\sb15\sl-230\slmult0 \up0 \expndtw-7\charscalex100 reached at 949.224.6436 or\par\pard\ql \li1322\sb14\sl-230\slmult0 \up0 \expndtw-3\charscalex100 bledger@buchalter.com. \par\pard\sect\sectd\sbknone \ql \li727\sb0\sl-161\slmult0 \par\pard\ql\li727\sb0\sl-161\slmult0 \par\pard\ql\li727\sb0\sl-161\slmult0 \par\pard\ql\li727\sb0\sl-161\slmult0 \par\pard\ql\li727\sb75\sl-161\slmult0 \up0 \expndtw-5\charscalex97 \ul0\nosupersub\cf4\f5\fs14 This alert is published as a service to our clients and friends. The material contained here is provided for informational purposes only and is not intended to constitute advertising, solicitation \par\pard\ql \li4299\sb19\sl-161\slmult0 \up0 \expndtw-5\charscalex100 or legal advice. For more information, visit \ul0\nosupersub\cf5\f6\fs14 www.buchalter.com\ul0\nosupersub\cf4\f5\fs14 . \par\pard\sect\sectd\fs24}